Healthcare Provider Details

I. General information

NPI: 1417041476
Provider Name (Legal Business Name): STEVEN K. LILJEGREN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 FAIRVIEW AVE
GROTON MA
01450-1201
US

IV. Provider business mailing address

26 FAIRVIEW AVE
GROTON MA
01450-1201
US

V. Phone/Fax

Practice location:
  • Phone: 978-877-0402
  • Fax:
Mailing address:
  • Phone: 978-448-9666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6815
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: